NPIMap

Individual provider Active NPI

Kenneth Johan, MD

  • Internal Medicine Physician
  • Victorville, CA
National Provider Identifier
1124690656
Registry record updated Sep 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A195154 Issued in CA
Practice address
16850 Bear Valley Rd
Victorville, CA 92395-5794
Phone
(760) 241-8000
NPI assigned
Jul 14, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 9, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X A195154 CA Primary

Addresses

Primary practice location

16850 Bear Valley Rd
Victorville, CA 92395-5794

Mailing address

16850 Bear Valley Rd Ste 203
Victorville, CA 92395-5794
Phone (760) 241-8000

Other practice location 1

234 E 149th St Ste 8-20
Bronx, NY 10451-5504
Phone (718) 579-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241008003993 CA Practitioner - Internal Medicine 9436680923 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Desert Valley Medical Group IncGroup PAC ID 4880595875, 78 clinicians

Practice addresses (Care Compare)

16850 Bear Valley Rd
Victorville, CA 92395-5794
Phone (760) 241-8000

Hospital & facility affiliations

  • Desert Valley Hospital Hospital, Victorville, CA, CCN 050709
  • Providence St Mary Medical Center Hospital, Apple Valley, CA, CCN 050300
  • Loma Linda University Medical Center Hospital, Loma Linda, CA, CCN 050327
  • Barstow Community Hospital Hospital, Barstow, CA, CCN 050298

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A195154CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Desert Valley Medical Group, Inc. Internal Medicine CurrentSince Oct 1, 2024 Accepting new patients
Desert Valley Medical Group, Inc. Current Accepting new patients
Desert Valley Medical Group, Inc Internal Medicine CurrentSince Oct 1, 2024 Accepting new patients
Desert Valley Hospital, LLC Past Accepting new patients

Locations

16850 Bear Valley Rd
Victorville, CA 92395
Phone (760) 241-8222

16850 Bear Valley Rd
Ste 102
Victorville, CA 92395

16850 Bear Valley Rd
Ste 203
Victorville, CA 92395

Interoperability endpoints

  • Direct secure messaging: kenneth.johan.p1@direct.dvmg.nextgenshare.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757376000000",
    "number": "1124690656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16850 BEAR VALLEY RD STE 203",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923955794",
            "telephone_number": "760-241-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16850 BEAR VALLEY RD",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923955794",
            "telephone_number": "760-241-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "234 E 149th St Ste 8-20",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104515504",
            "country_code": "US",
            "telephone_number": "718-579-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHAN",
        "first_name": "KENNETH",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-07-14",
        "last_updated": "2025-09-09",
        "certification_date": "2025-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A195154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Victorville, CA

Sources for this page

Verify at the official NPI Registry.